International Journal of Clinical Pharmacy

, Volume 34, Issue 4, pp 561–568 | Cite as

Irritable bowel syndrome and other gastrointestinal disorders: evaluating self-medication in an Asian community setting

  • Chong-Han KuaEmail author
  • Siow-Tian Ng
  • Reshma Lhode
  • Stefan Kowalski
  • Kok-Ann Gwee
Research Article


Background Gastrointestinal disorders frequently present symptoms which are often self-treated. Objective To record demographic profile of patients visiting community pharmacies for self-treatment with medications for gastrointestinal disorders, the number of these patients who fulfilled irritable bowel syndrome diagnostic criteria, and to judge the appropriateness of their treatment requests. Setting Singapore community pharmacies. Method The multicentre study was conducted using ROME III adapted criteria on adults above 18 years who have self-selected medicinal products for treatment of irritable bowel syndrome or gastrointestinal symptoms in the community pharmacy. Results Among those seeking self-medication, 36.8 % fulfilled criteria for irritable bowel syndrome, with irritable bowel syndrome-mixed (16.3 %) being the most prevalent subtype. For patients not fulfilling criteria for irritable bowel syndrome diagnosis, rates for other functional gastrointestinal disorders were constipation (20.5 %), dyspepsia (16.3 %), gastroesophageal reflux disease (12.1 %), diarrhoea (8.9 %), bloating (4.2 %), and heartburn (3.2 %). There were more females with gastrointestinal complaints. Overall, 21.6 % of the total participants had recently sought medical attention for their gastrointestinal complaint. 20 % of patients selected inappropriate medication for their gastrointestinal complaints, and the antacids class had the highest incidence of inappropriate medication use. Possible co-existing relationships were seen between gastroesophageal reflux disease with dyspepsia, irritable bowel syndrome with gastroesophageal reflux disease, irritable bowel syndrome with dyspepsia, and diarrhoea with constipation. Conclusion Patients who fulfilled criteria for irritable bowel syndrome had a high tendency to self-treat their gastrointestinal symptoms. Constipation complaints were also common. Around one in five patients self-medicated gastrointestinal symptoms inappropriately, with antacids being the most common.


Demography Functional gastrointestinal disorders Irritable bowel syndrome Self medication Singapore 



We would like to thank the participating pharmacists from the study centres, as well as students from the National University of Singapore, for their assistance in carrying out the study.


No funding obtained.

Conflicts of interest

None declared.


  1. 1.
    Thompson WG. The road to Rome. Gastroenterology. 2006;130:1552–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Bröker LE, Hurenkamp GJ, ter Riet G, Schellevis FG, Grundmeijer HG, van Weert HC. Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study. BMC Fam Pract. 2009;10:63.PubMedCrossRefGoogle Scholar
  3. 3.
    Wu JC. Gastroesophageal reflux disease: an Asian perspective. J Gastroenterol Hepatol. 2008;23:1785–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Chang JY, Locke GR III, McNally MA, Halder SL, Schleck CD, Zinsmeister AR, et al. Impact of functional gastrointestinal disorders on survival in the community. Am J Gastroenterol. 2010;105:822–32.PubMedCrossRefGoogle Scholar
  5. 5.
    Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhoea in the United States: prevalence and impact. Dig Dis Sci. 2000;45:1166–71.PubMedCrossRefGoogle Scholar
  6. 6.
    Guillemot F, Ducrotté P, Bueno L. Prevalence of functional gastrointestinal disorders in a population of subjects consulting for gastroesophageal reflux disease in general practice. Gastroenterol Clin Biol. 2005;29:243–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnsen R, Jacobsen BK, Førde OH. Associations between symptoms of irritable colon and psychological and social conditions and lifestyle. Br Med J (Clin Res Ed). 1986;292:1633–5.CrossRefGoogle Scholar
  8. 8.
    Cremonini F, Talley NJ. Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors. Gastroenterol Clin North Am. 2005;34:189–204.PubMedCrossRefGoogle Scholar
  9. 9.
    Hungin AP, Whorwell PJ, Tack J, Mearin F. The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects. Aliment Pharmacol Ther. 2003;17:643–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Saito YA, Schoenfeld P, Locke GR III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol. 2002;97:1910–5.PubMedGoogle Scholar
  11. 11.
    Sperber AD, Dekel R. Irritable bowel syndrome and co-morbid gastrointestinal and extra-gastrointestinal functional syndromes. J Neurogastroenterol Motil. 2010;16:113–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Gwee KA, Wee S, Wong ML, Png DJ. The prevalence, symptom characteristics, and impact of irritable bowel syndrome in an asian urban community. Am J Gastroenterol. 2004;99:924–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Wilson S, Roberts L, Roalfe A, Bridge P, Singh S. Prevalence of irritable bowel syndrome: a community survey. Br J Gen Pract. 2004;54:495–502.PubMedGoogle Scholar
  14. 14.
    Kwan AC, Hu WH, Chan YK, Yeung YW, Lai TS, Yuen H. Prevalence of irritable bowel syndrome in Hong Kong. J Gastroenterol Hepatol. 2002;17:1180–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Amouretti M, Le Pen C, Gaudin AF, Bommelaer G, Frexinos J, Ruszniewski P, et al. Impact of irritable bowel syndrome (IBS) on health-related quality of life (HRQOL). Gastroenterol Clin Biol. 2006;30:241–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Brun-Strang C, Dapoigny M, Lafuma A, Wainsten JP, Fagnani F. Irritable bowel syndrome in France: quality of life, medical management, and costs: the Encoli study. Eur J Gastroenterol Hepatol. 2007;19:1097–103.PubMedCrossRefGoogle Scholar
  17. 17.
    Li FX, Patten SB, Hilsden RJ, Sutherland LR. Irritable bowel syndrome and health-related quality of life: a population-based study in Calgary. Alberta Can J Gastroenterol. 2003;17:259–63.Google Scholar
  18. 18.
    Faresjo A, Grodzinsky E, Johansson S, Wallander MA, Faresjo T, Timpka T. Self-reported use of pharmaceuticals among patients with irritable bowel syndrome in primary care. J Manag Care Pharm. 2008;14:870–7.PubMedGoogle Scholar
  19. 19.
    Icks A, Haastert B, Enck P, Rathmann W, Giani G. Prevalence of functional bowel disorders and related health care seeking: a population-based study. Z Gastroenterol. 2002;40:177–83.PubMedCrossRefGoogle Scholar
  20. 20.
    Kong SC, Hurlstone DP, Pocock CY, Walkington LA, Farquharson NR, Bramble MG, et al. The Incidence of self-prescribed oral complementary and alternative medicine use by patients with gastrointestinal diseases. J Clin Gastroenterol. 2005;39:138–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Lembo A. Irritable bowel syndrome medications side effects survey. J Clin Gastroenterol. 2004;38:776–81.PubMedCrossRefGoogle Scholar
  22. 22.
    van Tilburg MA, Palsson OS, Levy RL, Feld AD, Turner MJ, Drossman DA, et al. Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO. BMC Complement Altern Med. 2008;8:46.PubMedCrossRefGoogle Scholar
  23. 23.
    Strand LM, Morley PC, Cipolle RJ, Ramsey R, Lamsam GD. Drug-related problems: their structure and function. DICP. 1990;24:1093–7.PubMedGoogle Scholar
  24. 24.
    Devanarayana NM, Adhikari C, Pannala W, Rajindrajith S. Prevalence of functional gastrointestinal diseases in a Cohort of Sri Lankan adolescents: comparison between Rome II and Rome III Criteria. J Trop Pediatr. 2011;57:34–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Park DW, Lee OY, Shim SG, Jun DW, Lee KN, Kim HY, et al. The differences in prevalence and sociodemographic characteristics of irritable bowel syndrome according to Rome II and Rome III. J Neurogastroenterol Motil. 2010;16:186–93.PubMedCrossRefGoogle Scholar
  26. 26.
    Key Annual Indicators—Literacy & Education (Educational Attainment among resident non-students aged 25-39 years 2011), Singapore Department of Statistics. Accessed 05 February 2012.
  27. 27.
    Gwee KA, Lu CL, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: something old, something new, something borrowed. J Gastroenterol Hepatol. 2009;24:1601–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Gerson CD, Gerson MJ, Awad RA, Chowdhury A, Dancey C, Poitras P, et al. Irritable bowel syndrome: an international study of symptoms in eight countries. Eur J Gastroenterol Hepatol. 2008;20:659–67.PubMedCrossRefGoogle Scholar
  29. 29.
    Kaji M, Fujiwara Y, Shiba M, Kohata Y, Yamagami H, Tanigawa T, et al. Prevalence of overlaps between GERD, FD and IBS and impact on health-related quality of life. J Gastroenterol Hepatol. 2010;25:1151–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Nakajima S, Takahashi K, Sato J, Fukuda M, Yamamoto K, Inoue T, et al. Spectra of functional gastrointestinal disorders diagnosed by Rome III integrative questionnaire in a Japanese outpatient office and the impact of overlapping. J Gastroenterol Hepatol. 2010;25:S138–43.PubMedCrossRefGoogle Scholar
  31. 31.
    Ramage-Morin PL. Medication use among senior Canadians. Health Rep. 2009;20:37–44.PubMedGoogle Scholar
  32. 32.
    Charles J, Harrison C. Irritable bowel syndrome in Australian general practice. Aust Fam Phys. 2006;35:840–1.Google Scholar
  33. 33.
    Department of Statistics, Ministry of Trade & Industry, Republic of Singapore. Monthly Digest of Statistics Singapore. Singapore. Jan 2012:4–5.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Chong-Han Kua
    • 1
    • 2
    Email author
  • Siow-Tian Ng
    • 1
  • Reshma Lhode
    • 1
  • Stefan Kowalski
    • 2
  • Kok-Ann Gwee
    • 3
  1. 1.Pharmacy Practice DepartmentGuardianSingaporeSingapore
  2. 2.Division of Health Sciences, School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
  3. 3.Stomach Liver and Bowel ClinicGleneagles HospitalSingaporeSingapore

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